Redefining Child Protection: Addressing the Harms of Structural Racism and Punitive Approaches for Birthing People, Dyads, and Families Affected by Substance Use.

There has been growing attention on the effect of substance use, including opioid use disorder, on pregnant and birthing people and their infants. Although effective medication treatment for opioid use disorder is the standard of care, racial disparities are evident in access during pregnancy. Structural racism affects treatment access and approaches to reporting to child welfare services. Black people and their newborns are more likely to be drug tested in medical settings, and Black newborns are more likely to be reported to child welfare services. Child welfare models often focus on substance use as being the dominant issue that drives risk for abuse or neglect of a child, and current reporting practices, which vary by state, contribute to these disparities. This commentary proposes an alternate way of thinking about family-based support. We suggest changes to law, institutional policy, clinical care, and ideology. Specifically, we propose realigning around shared goals of supporting the birthing person-infant dyad and recognizing that substance use is not synonymous with abuse or neglect; creating an anonymous notification process outside of the child welfare system to meet federal data-collection requirements; limiting perinatal drug testing and requiring written, informed consent for parental and neonatal testing; and developing integrated care teams and hospital settings and policies that support dyadic care.

A Multispecialty Perspective on Physician Responsibility to Sexual Assault Survivors.

As physicians who represent differing specialties of obstetrics and gynecology, psychiatry, and pediatrics, we have repeatedly experienced stories of sexual assault in the context of our various patient encounters. Although our individual specialties give detailed guidelines for physicians and cover the medical, legal, and mental health aspects, we propose that all physicians should use another category called social responsibility. The mainstay of our social responsibility is to provide the victim with the support and resources to overcome this trauma. We outline the tenets of social responsibility as prevention, trust, reassurance, and resource allocation. We hope to illustrate the importance of advocating for uniform adoption of a trauma-informed care approach to sexual assault survivors.